HomeMy WebLinkAbout04-1064
PETITION FOR PROBATE and GRANT ~F L~TTERy
Estate of /< q +ha r I h e. 7. A yv50 No. 9../ 0'/ /00
also known as kq v A" V50 To:
/ I Register of Wills for~he I d
Deceased. in the
o Cf g .- I (;, - '}3 8 b County of ~!d~ r q II
Social Security No. Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the exec"t Pe,'~ e- l" 8, Shil It zejk"l -;;~~;d .
in the last will of the above decedent, dated H 4 V C; ,w~3
and codicil(s) dated I
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in C VPI h.erJcp,d County, Pennsyl:ria, with
he.r last family or principal residefF,e at :2./0 8/j .5;~rJYJJ Ro~'
NelA/v' lie.. A /'7.2 If / I
(list street, number and muncipality)
J/oV e 1I1~e. yo- '8 ,19: .2,00 Lf,
at vv I ~/+ I\I~ Iv / /1 1'A
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows: $ :<S~ OeJO
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania $ .I
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows:
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters
(testamentary; administratiolH:,t;a.; administration d.b.n.c.t.a.)
theron. ;,..:" . C)'
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OATH OF'PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA .. 55
COUNTY OF J
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well uly administe t est e cording to law.
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No. ;{/ -()Lj -I OIoL/
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Est~te of , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW ;(~~4 o.yor "",,,,,,tux 19~. in consideration oithe petition 00
the reverse side hereof, satisfactory proof having been prese"lte . efore me,
IT IS DECREED that the instrument(s) date" ()
described thereinJ:e admitted to pro~ and filed of recor
~ f"ll\..l.... ~D ,
and Letters 0
are hereby granted to 0/
)J
FEES ' Register of Wills I
.....-.
Probate, Letters, Etc. ......... $ ~ r~
Short Certificates( ).......... $ ATIORNEY:4sup. Ct. 1.15: No.)
Renunciation ................ $ c...
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$ ADDRESS --"
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TOTAL _ $
Filed ................................... '.~
PHONE "
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- 3L\.egister of Wills of QCumherlanb QCountp
OATH OF SUBSCRIBING WITNESS
Estate of /(q)/,q-V'/t/. ~ T. AVP0Z;> No. ~/f6tj-/Ob C;
, / .
Also lmown as Ir-r 1 S Y v..i l)
, Deceased
fJ~ Ie. V'- [3, .s h vi 1-I-z;.er6.-, J e'v'o
(each) a subscribing witness to the will/codicil presented herewith, (each) being duly qualified
according to law, depose(s) and say(s) .:L. present and saw
/(4-r~q V' nz e.- T A f v So, the testat1.X...-, sign the same and
that gZ signed as a witness at the request of the testat 1'.:>( in h~ presence
and (in the presence of each other) (in the presence of the other subscribing witness(es).
-/J~ g-~
(Name)
..-..... .'--
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(Address) .........:.'-
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Sworn to or affirmed anVf};sCribed
Before me this / day of 'J
Npve;Y'l b,...,.. , 20 a Vi
~ ~. ~ame)
~ j~ iJj
For the Register ?- L ~ 'L..--- (Address)
- i\egi~ter of WiH~ of C!Cumberlanb C!Countp
OATH OF SUBSCRIBING WITNESS
Estate of k4j-~ q r /1\ ~ T AytJso No. ~ I - 0 '-{- I D~ i
,
Also mown as k.,v 4 V vS 0
/ /
, Deceased
C ~ er yo / It> -If e /1. ({owe.,rs
(each) a subscribing witness to the will/codicil presented herewith, (each) being duly qualified
according to law, depose(s) and say(s) -::z:. present and saw
/r4y 4 'j1/.5 ~ , the testat.i2L, sign the same and
that I.. signed as a witness at the request of the testat 1'1.. in h~ r presence
and (in the presence of each other) (in the presence of the other subscribing witness(es).
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(Name) ~~-
3J.3 6oik:. (ItU(C/1~. )JeltuVt/1 L
(Address) (JA /7;}-4.P
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Sworn to or affirmed and subscribed 7bA-' if <-j(~
Be~ me this 19T^- day of
b1Ifl....j,-<.~ ,20.2.:L
'7d'd9l~ (Name) de {;.I t/ , / /('
d/o3~ fr':Vr ~c1, t, /7d</1
For the Register YLVANIA (Address) ,
COMMONVYEAL TH OF PENNS
Notarial Seal ,
V i' L Hopl''''''. Nqlary Public
IC,', .. . r1 nd County
West Per-nsborc- ! \',,) !.}m~ a 008
M ComrnisslOf ':, ,.(. e"ldlt. 15,2
Y -'--'''.-:'':::;ion Of Notaries
Member, Pennsy~\ldn18, A~S.U...-d
Thi~ i\ to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
I., led I{egistrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fcc for this certificate. :<>2.00 ~7ifij;;;;;; ~- /1,? %4u.'7<-
\III{~\.1\\ OF pl;;",,--__
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'~_c.<, Local Registrar _
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P 10687563 -~~. &" ..r~ ~V 1 0 2004
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No, ,......"""",,,,,,/I}/I"'" Date
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I J fh:v 2187 COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
- ~.... ==---==--=-:o.=.------==-~_-==._ . STAlE FilE ~UW8EA
tiAME OF OeCEDENT {F '(SI. MldOle, L ilSlJ SEX SOCIAL SECURITY NUMBER
t. Katharine T. Ayuso ., Female ], 098 - 16 - 1386
-AGE (last 8w1hdav) UNDER 1 YEAR UNDER 1 D/Ilt BlRTHPlACf rc,ly..r.d
Monlho ! D... HounI : Minut.. Slale Of f Cftlogtl COUOltyl
. ,~ 0040 =...,0
86 v,.. . E~I"nlLJ
. .
. COUNTY OF OEJa'H RACE . AIMnUn Indian, 8&ac:k, 'Mule. ilk
(Spoc.t,)
. umberland White
...,
DECEDENT'S USUAl OCCUPArION IwlAAITAl STATUS - Yarned SURVIVING SPOuSE
(~:o,~lif~~~::~~ N...,., Mvrlltd. WIdowN. tlf ""'.. g..... maiden natnIIl
"""'- (SpecOy)
. ".. Chemist ,,~. A&P Foods '4,Never Married 11.
UECEDENT"S MAILING ADDRESS ($1,_. ClfVl1Own, s.a... ZIIpCOdeI DECEDENT'S 17.. 51... P A 17.,~.___.. West Pennsboro
. 341 Barnstable Road ACTUAL (l;d .....
RESIDENCE --
Carlisle, PA 17013 (See .nsh'UCltOf\I ......
on oIh81 !Ide) IOwnship1 17d.O :"~=of
I.. 1...,Councy r.llmhf'rl and """-
fAlHER'S NAME (First. MIOdIe. La") MOTHEA'S NAME ,Fils!. Moddle. MiIlden Surname)
...Arthur Ayuso
INfORMANT'S NAME (T ypelP'inf)
.... eter Schultzaber er
METHOD OF DISPOSITION Cremation ~ R.mowaIlrorn Stale 0
. _0
DonaIion 0 au... (SpocAy.
. 21..
NoD
'4. ... '5. 21.
21. MAT I: Ent.r t.... diseases. injuries 01' compllcahol. which caused lhe dealh. Do noleruer the ~ 01 dying, such as ca,dlac or esPi,alory .118$1, shock or he,;jt1 falluI. I AppIoatmaC. PART I: 0thlN SigntficanI concIiIiona cnnIrllUing lo ...1h. bur
list ontv one cause on .ach Me :~~ nol resuling in IN undIr1ytng C.uN g;... in PAAT I
.' ~ kdl~~ I /JuJ.~':t~ IJw
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OUElO(ORASAC OUENCEOF): ,
I: .
DUE lO(OAASA CONSEQUENCE OF}: I
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I
DUE 10(00 AS -CONSEOUENCE Ofj, I
,
.
WERE AUlOPSY FINDINGS MANNE A OF DEATH DATE OF INJURY TIME OF INJURV INJURY AT WORK? DESCRIBE HON INJURY OCCURRED.
~ILABlE PRIOR m ~ CMoolh. D.aV. Veal}
COMPLETION OF CAUSE 0
OF OEMH7 HaI",a' HomICide _0 NoD
......nI 0 Pandtng Inveslig.llhon 0
v.. 0 No~ 0 o ~E OF INJURY - AI home. ta,~.a:;"I. 'ac1~, otfic. .., :JOe.
No - Coukj not till del.,mlned
buiking, ate: lSpeclfvl
,.., ...., 2t, -,
CIRTIFIER ,Check onty onel
'CERTIFYING PHYSICIAN (Physoe....... cerlllV"'9 CCWH 01 dealh .....hen oinother J)hvSI(;:.an hits PfOOOt..nced lJedltl dflO comPl"'I~ Item 2J) 0
To the btlalO'M, knowledge, d..tJtoccurrwcI...1o tttecauM(s. andmann.r ...r.ted...... ..... ............ .......
'PRONOUNCING AND CERTIFYING PHYSICIAN iPhVSICIClf1 both OlI01louf"lng oed1h and (':ef'lllylO9lOcavse 01 dealh)
To ItM M.I of my knowledge. dealh OCcurred .II IN u.n., d.la, and pika, and due to lhe cau"(a) and manner.. s.aCed.. _ _ . . . . .
'MEDICAL EXAMINER/CORONER
On the b..i. 0' axaminatlon and/or investigation, in my opinion, death occurred a'the Ume. date, and place. and due to the cause(s)and 0
menn., a. .tated.. . . . . . . _ . .. . . . . . . . . . . ... . ... ........................... _ . .. .................................. _. /lr ,c. ,',-,' />L'i(
... ]2,
REGISl~ATUA:mU~ !::><II ~I /,/1 DATE FILED(MonIh Day. Yeal)
JJ z.... (/:7 a--j-tZt1~~.-;,!Z..,...,,;?:_., 7?~) /~ ,-7 /? I'" ...;
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Last Will and Testament
I, KATHARINE T. AYUSO, of West Pennsboro Township, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament and revoke any Will or
Codicil previously made by me.
ITEM I: I direct that all my just debts (except as may be barred by a Statute of
Limitations) and my funeral expenses (including expenses of my last illness) shall be
paid from my residuary estate as soon as practicable after my decease as a part of the
administration of my estate. I direct my Executor to carry out my funeral in accordance
with the instructions that I have previously given to him and to have my ashes sent to
Mount Auburn Cemetery in Cambridge, Massachusetts.
ITEM II: I give and bequeath all my tangible personal property, including but not limited
to, furniture and furnishings, china, silverware, jewelry, ornaments, works of art, books,
pictures, wearing apparel and personal effects, to my friend, JANET H.
SHULTZABARGER, providing she shall survive me. Should JANET H.
SHULTZABARGER not survive me, it should be directed to her husband and my friend
PETER B. SHUL TZABARGER. If neither survives me, then the above articles should
be distributed to their descendants.
ITEM III: I devise and bequeath the residue of my estate of every nature and wherever
situate to JANET H. SHULTZABARGER. Should she predecease me, I devise and
bequeath the residue of my estate of every nature and wherever situa~ to PETER B.
SHULTZABARGER. If both have predeceased me, I devisee and beqUeath tftij residue
of my estate of every nature and wherever situte in equal shares to JENNlFERS.
FORBES and KATHARINE J. HOUCK. Should any of these beneficiaries predecease
me, but leaving descendants who do survive me, such descendants shall recei~ per
stirpes, the share that such predeceased beneficiary would have received had they
survived me. ::~
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ITEM IV: If any property passes outright (either under this Will or otherwise)To a minor
(which shall be defined as anyone under twenty-one (21 years of age) and with respect to
which I am authorized to appoint a guardian and have not otherwise specifically do so, I
decline to appoint a guardian but instead authorize my Executor to distribute such
property to a Custodian selected by my Executor (and my Executor may act as such
Custodian) as Custodian for the no more under the Pennsylvania Uniform Transfers to
Minors Act. Provided, however, that this appointment shall not supersede the right or
any fiduciary to distribute a share where possible to the minor or to another for the
minor's benefit.
ITEM V: I direct that all taxes that may be assessed in consequence of my death, of
whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary
estate as part of the expenses of the administration of my estate.
.
.
ITEM VI: I appoint PETER B. SHUL TZABARGER, Executor ofthis my Last Will.
Should PETER B. SHUL TZABARGER fail to qualify or cease to act as Executor, I
appoint JANET H. SHULTZABARGER, Executrix ofthis my Last Will. Ifneither
qualify I appoint JENNIFER S. FORBES, Executrix of this my Last Will
ITEM VII: I direct that my Executor or their successors shall not be required to give
bond for the faithful performance of their duties in any jurisdiction.
ITEM VIII: My individual fiduciary shall be entitled to reasonable compensation for this
or her services rendered from time to time and to reimbursement of out of pocket
expenses.
ITEM IX: The interests ofthe beneficiaries hereunder shall not be subject to anticipation
or to voluntary or involuntary alienation.
I, KATHARINE T. AYUSO, the Testatrix whose name is signed to the attached
or foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will; and that I signed
it willingly and as my free and voluntary act for the purposes therein expressed.
_i~~~'1' l ~ : \6"'\ \t)0
KATHARINE T. AYUSO Date
~ fie I> III J1 sJ J1,~)~,-e'-
We, tizCl-r ~1 f}/J. oW'C!rs and .e;,. €v . ~ ~the witness
whose names are signed to the attached or foregoing instrument, being duly qualified
according to law, do depose and say that we were present and saw the Testatrix sign and
execute the instrument as her Last Will; that the Testatrix signed willingly and executed it
as her free and voluntary act for the purposes therein expressed; that each subscribing
witness in the hearing and sight of the Testatrix signed the Will as a witness; and that to
the best of our knowledge the Testatrix was at that time eighteen (18) or more years of
age and or sound mind and under no constraint or undue influence.
Witness ~~ hi . ;!;O~ Date S- /'3 Ie 3
Witnessft8 ~ Dale 7YOs
:=:jr'}~,'lON\;\'EALTH 0" F[\.~'JSYLIjA~JIA r,EV-1162 EX(11-96i
nF="'A'1TlvlE',r JF REV~~JUE
6L;REAL; OF INJIIj,DLAl TAXES
DEPT 28060'
I-ARR,SBURG, F'A 171220601
PENNSYLVANIA
RECEIVED ~ROM, INHERITANCE AND EST A TE TAX
OFFICIAL RECEIPT
NO. CO 004918
SHUL TZABARGER PETER B
341 BARNSTABLE ROAD
CARLISLE, PA 17013
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-- 'l'ld ________u
101 I $39,446.80
ESTATE INFORMATION: SSN: 098,16,1386 I
FILE NUMBER: 2104-1064 I
DECEDENT NAME: AYUSO KATHARINE T I
DA TE OF PAYMENT: 02/07/2005 I
POSTMARK DATE: 02/07/2005 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 11/08/2004 I
I
TOTAL AMOUNT PAID: $39,446.80
REMARKS: P SHUL TZABARGER
CHECK#1005
INITIALS: VZ
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
f'U_',:_;:E~S;:~
jj). ADbL ~<D IJA rE ~
REV-1500
.-. COMMONWEALTH OF
_. . . PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPl 280601
.~ HARRISBURG, PA 1712a.ool1
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21 04
01064
COUN'YCODE YEAR
NUMBER
DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL)
AYUSO, KATHARINE T
SOCIAL SECURITY NUMBER
098-16-1386
I-
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C
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C
DATE OF BIRT~ (MM-DO-YEAR)
D6/25/1918
DATE OF DEATH (MM-DD.YEAR)
11/D8/2D04
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST FIRST AND MIDDLE INITIAL)
NA
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~ 1 Original Return
o 4. LimrtedEstate
o 6. Decedent Died Testate (A:'.adl c:::py ~ WI!;
o 9. litigation Proceeds Rernived
D 2. Supplemental Retum
D 48. Future Interest Compromise lda:!'~' rlffi:h a':cr '2-'2-<i2~
D 7. Decedent Maintained a Living Trust {A::adl!4lY :tTrus:)
o 10. Spousal Poverty Credit {da:e ~':1ea:tolJe:weef1 .2-3~-9~ an::! -"-95'
03. Remainder Return Ija:e~'jro:hpnnr::J '2-'3-<i2:
D 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (A:;ad", $chC:
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CDNADENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Peter B Shullzabarger, executor 341 Barnstable Rd, CARLISLE, PA 17D13
FIRM NAME iI' Ap~lUtJle:
NA
TELEPHONE NUMBER
(717) 249-8644
,. Real Estate (Schedule A) (1) O.OD
2. Stocks and Bonds (Schedule B) (2) 272,766.38
3 Closely Held Corporation. Partnership or Sole-Proprietorship (3) D.OO
4 Mortgages & Notes Receivable (Schedule 0) (4) D.DD
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 3D,698.96
Z (Schedule E)
0 6. Jointly Owned Property (Schedule F) (6) D.DD
~ o Separate Billing Requested
..J (7) D.DD
:J 7 lnter-Vivos Transfers & Miscellaneous Non-Probate Property
!::: :'ScheduleGor L)
a.. (8) :iO~,465,34
<{ 8 Total Gross Assets (total Lines 1-7)
U 9 Funeral Expenses & Administrative Costs (Schedule H) (9) 1,815.DO
W
0:: 24,830.66 c
10. Debts of Decedent. Mortgage Liabilities. & Liens (Schedule I) (10)
11 Total Deductions (total Lines 9 & 10) (11) 26,645,66
12 Net Value of Estate (Line 8 minus Line 11) (12) 276,819.68
13 Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) DOD
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 276,819,68
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of line 14 taxable at the spousal tax D.DD
rate. or transfers under Sec. 9116 (a)(1.2) --.------------ , 0 (15)
16. Amourlt of Line 14 taxable at lineal rate ------------.--------- , .0 (16) D.DD
17 Amount 01 Lirle 14 taxable at sibling rate x.12 (17) D.DD
18. Amount of Lirle 14 taxable at collateral rate 276,819.68 , 15 (18) 41.522.95
19. Tax Due (19) 41 ,522,95
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TD ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
r,
Decedent's Complete Address:
STREET ADDRESS
Swaim_Health Cer)ler
~. 2~Big Spring_ Rd
CITY NEWVILLE
- -FE~A-
I liP
17241
Tax Payments and Credits:
1. Tax Due (Page 1 line 19)
2. CreditS/Payments
A. Spousal Poverty Credit
B. Pnor Payments
C. Discount
(1)
41,522.95
.2,076.15
Total Credits ( A + 8 + C ) (2)
2,076.15
3. InteresUPenalty If applicable
a.lnterest
E. Penally
5.
If Line 1 + Line 3 is greater than Line 2. enter the difference. This IS the TAX DUE.
(3)
(4)
(5)
0.00
Total InteresUPenalty ( 0 + E )
If Line 2 :s greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
4.
A. Enter the Interest on the tax due.
(5A)
0.00
39,446.80
0.00
S. Enter the tolal of line 5 + SA. This is the BALANCE DUE.
(58)
39,446.80
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred.. ....,....... 0 [il
b. retain the right to deSignate who shall use the property transferred or ItS Income: . . . 0 [i]
c. retam a reversionary Interest: or... ... 0 [!]
d. receive the promise for life of either payments, benefits or care?.. .."''''........ 0 [i]
2. If death occurred after December 12. 1982, did decedent transfer property within one year of death
Without receiving adequate consideration?. .. ..................... 0 [K]
3 Did decedent own an "in trust for" or payable upon death bank account or security at hiS or her death? . .. ........ 0 [iJ
4. Old decedent own an Individual Retirement Account. annuity. or other non-probate property which
contains a beneficiary designation? ..... ............... .... ...... 0 [il
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penaties of pelJUf)'. I decl(l'e thai I have exanined tis retLrn, induang accompanying schec1lles ;nd statements, and 10 1he best of my knowledge iIfld belief, it is true, correct
ax! canplele.
Dedaratirn ofpreparer other than tie personal rep-esentaWe is based on all information ofwtWch prepafel"has any 1oYJlMedge.
SIGNATUR~~RE5lESIBLE~
ADDRESS
3'1/ t3"1"'-Jf7J/e-. /?cl_ c.. r /,S / e-
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
_nn_ /V A_n_n
ADDRESS
D~
..2./ ~/<~~-
fJlt
/'7c>/.1
DATE
For dates of death on or after July 1. 1994 and before January 1, 1995. the tax rate imposed on the net value of transfers 10 or for the use 01 the surviving spouse IS 3%
[72 P.S. \9116 (a) (1.1) (ill.
For dates of death on or after January 1, 1995. the tax rate imposed on the net value of transfers to or for the use 01 the surviving spouse IS 0% [72 P.S. 99116 (a) (1.1) (ill],
The statute does not exemot a transfer to a surviVing spouse lrom tax, and the statutory requirements for disclosure of assets and filing a lax return are sllll applicable even if
the surviving spouse IS the only benefiCiary.
For dates of death on or after July 1. 2000:
The tax rale imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent an adoptive parent.
or, stepparent of the child IS 0% [72 P.S. \91t6(')(1.211.
The tax rate imposed on the net value of transfers 10 orfor the use of the decedent's lineal benefiCiaries Is4.5%, except as noted in 72 P.S. S9116(1.2) [72 P.S. s9116(a)(1)].
The tax rate imposed on the net value 01 transfers to or for the use of the decedent's siblings is 12% (72 P.S. 99116(a)(1.3)). A Sibling is defined, under Section 9102, as an
individual who has at least one parent In common with the decedent, whether by blood or adoption.
Last Will and Testament
I, KATHARINE T. AYUSO, of West Pennsboro Township, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament and revoke any Will or
Codicil previously made by me.
ITEM I: I direct that all my just debts (except as may be barred by a Statute of
Limitations) and my funeral expenses (including expenses of my last illness) shall be
paid from my residuary estate as soon as practicable after my decease as a part of the
administration of my estate. I direct my Executor to carry out my funeral in accordance
with the instructions that I have previously given to him and to have my ashes sent to
Mount Auburn Cemetery in Cambridge, Massachusetts.
ITEM II: I give and bequeath all my tangible personal property, including but not limited
to, furniture and furnishings, china, silverware, jewelry, ornaments, works of art, books,
pictures, wearing apparel and personal effects, to my friend, JANET H.
SHULTZABARGER, providing she shall survive me. Should JANET H.
SHULTZABARGER not survive me, it should be directed to her husband and my friend
PETER B. SHULTZABARGER. Ifneither survives me, then the above articles should
be distributed to their descendants.
ITEM ill: I devise and bequeath the residue of my estate of every nature and wherever
situate to JANET H. SHULTZABARGER. Should she predecease me, I devise and
bequeath the residue of my estate of every nature and wherever situate to PETER B.
SHULTZABARGER. Ifboth have predeceased me, I devisee and bequeath the residue
of my estate of every nature and wherever situte in equal shares to JENNIFER S.
FORBES and KATHARINE J. HOUCK. Should any of these beneficiaries predecease
me, but leaving descendants who do survive me, such descendants shall receive, per
stirpes, the share that such predeceased beneficiary would have received had they
survived me.
ITEM IV: If any property passes outright (either under this Will or otherwise) to a minor
(which shall be defined as anyone under twenty-one (21 years ofage) and with respect to
which I am authorized to appoint a guardian and have not otherwise specifically do so, I
decline to appoint a guardian but instead authorize my Executor to distribute such
property to a Custodian selected by my Executor (and my Executor may act as such
Custodian) as Custodian for the no more under the Pennsylvania Uniform Transfers to
Minors Act Provided, however, that this appointment shall not supersede the right or
any fiduciary to distribute a share where possible to the minor or to another for the
minor's benefit.
ITEM V: I direct that all taxes that may be assessed in consequence of my death, of
whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary
estate as part of the expenses of the administration of my estate.
ITEM VI: I appoint PETER B. SHULTZABARGER, Executor of this my Last Will.
Should PETER B. SHUL TZABARGER fail to qualify or cease to act as Executor, I
appoint JANET H. SHULTZABARGER, Executrix of this my Last Will. Ifneither
qualify I appoint JENNIFER S. FORBES, Executrix of this my Last Will
ITEM VII: I direct that my Executor or their successors shall not be required to give
bond for the faithful performance oftheir duties in any jurisdiction.
ITEM VIII: My individual fiduciary shall be entitled to reasonable compensation for this
or her services rendered from time to time and to reimbursement of out of pocket
expenses.
ITEM IX: The interests of the beneficiaries hereunder shall not be subject to anticipation
or to voluntary or involuntary alienation.
I, KATHARINE T. AYUSO, the Testatrix whose name is signed to the attached
or foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will; and that I signed
it willingly and as my free and voluntary act for the purposes therein expressed.
d& ~~ or: 0'6..yu-
THARINE T. AYUSO
~\<\\o1>
Date
We, (:)Jar'/d-Je- fYt. fSovJer.s and (i1e...8JL/-}~b":f~~ witness
whose names are signed to the attached or foregoing instrument, being duly qualified
according to law, do depose and say that we were present and saw the Testatrix sign and
execute the instrument as her Last Will; that the Testatrix signed willingly and executed it
as her free and voluntary act for the purposes therein expressed; that each subscribing
witness in the hearing and sight of the Testatrix signed the Will as a witness; and that to
the best of our knowledge the Testatrix was at that time eighteen (18) or more years of
age and or sound mind and under no constraint or undue influence.
Witness bI~j/J1, ~cJ~ Date -s-/fi /0.2
Wi""~ ;JlsJ!fly,
Date 5/ ]:/,0 ?
/
REV.1503 EX+ (6-98)
..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDFNT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
AYUSO, KATHARINE T.
FILE NUMBER
:1./ - 2004-01064
All property joindy-owned witn right of survivorsnip must be disclosed on Scnedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
,. 1,404.893 sh Growth Fd of America AGTHX (mutual fund) 35,487.60
2 2,522.588 sh Income Fd of America AMECX (mutual fund) 45,557.94
3 2,753.121 sh Intermediate Bond Fd of America AIBAX (mutual fund) 29,926,43
4 1,107.444sh New Perspective Fd ANWPX (mutual fund) 29,23652
5 995.757 sh Putnam Gr and Inc Fd PGIBX (mutual Fund) 18,292.06
6 2,223.379 sh Washington Mutuallnveslment Fd AWSHX (mutual fund) 67,168.28
7 1,000 sh Servicemaster Co common stock SVM (stock) 12,570.00
Stock held outside brokerage account
8
1,225.685 sh PFIZER Inc. common stock
PFE
(stock)
34,52755
TOTAL (Also enter on line 2, Recai>lulalion) $
272,766.38
(If more space is needed, insert additional sheets of the same size)
Kay Ayuso Individual Account
f3ro.k,,~ A,,-v-f-
Mutual Fund Svmbol Close 11/08/04 000 # of Shares Total
AGTHX 25.26 1.404893 $35.487.60
AMECX 1806 2,522.588 $45,55794
AIBAX 10.87 2,753.121 $29,926.43
ANWPX 26.4 1,107.444 $29,236.52
PGIBX 18.37 995.757 $18,292.06
SVM 12.57 (avo of Hi and La 1,000 $12,570.00
AWSHX 30.21 2,223379 $67,168.28
Kay Ayuso IRA
Mutual Fund Svmbol
AMECX I
Close 11/08/04 000 # of Shares Total
1806 I 1,613.951 I $29:147961
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Investment Plan Statement for Shareholders of
PFIZER INC.
1.,,111,.,1,.1.1,1.,1...111.1...1.,11.1.,1,..1...1111,.,.1.1.1
KATHARINE T AYUSO
210 BIG SPRING RD
NEWVILLE PA 17241-9497
Shareholder Services
P.O Box 43081
Providence, RI 02940-3081
If you have any questions regarding your
account, please call Shareholder Services at
1-800-733-9393.
Internet: http://www.equiserve.com
26492004109115 131622
Issue# Account# Stock Symbol
2649 723-47648 PFE
SA VE THIS STA TEMENT FOR TAX PURPOSES
Dividend Information
Record Date: Au 13,2004 I Pavable Date: Sen 03. 2004 I Orvidend OPtion: Full Reinvestment
RECORD DATE SHARES FOR REINVESTMENT Amount Withhgk:l From Gross Net Amount
Security Certificate Shares I Plan Shares I Total Shares Rate($) Gross Amount($) Tax($) I Fee($) Reinvestod($)
COMMON STOCK I 1,219.3651 1.219.365 0.17000 207.29 I 207.29
Plan Account Activitv
Date Description Fa9S ;:md'or Net Dollar Arnount($) Price per I ransac1ion Shares Totai Shares Held
Commissions($) Share($)
01/02/2004 Balance Forward 1,208.105 1.208.105
03/05/2004 Common Dividend Purchase 205.38 37.290 5.508 1,213.613
06/04/2004 Common Dividend Purchase 206.31 35.870 5.752 1,219.365
09/03/2004 Common Dividend Purchase 207.29 32.800 6.320 1.225.685
Year-To-Date Investment Summary
Net Divi<:llmds Reinvested($) I
618.98 I
Tax Withheld{S)
Optionallnvestments($) I Other lnvestments($) lFees ao?'or Commissions Tax Reportable Company-Paid
I Paid by You($) Fees and/or Commlsslons($)
I I
Totallnvestments($}
618.98
Total Holdings and Market Value
Security Certificate Shares
COMMON STOCK
Plan Shares
(As of the close of business on 09/1012004)
Total Shares Price per Share($) Market Value($l
1,225.685
1,225.685
31.860
39,050.32
ACCESS YOUR ACCOUNT ONLINE
You can now access and manage your account online through the EquiServe web site. All you need is Pfizer's issue ID (2649),
your account number (00723-47648), your social security number (if applicable) and your initial password (54844614). Simply
go to www,equiserve.com and click on "Account Access."
Alternatively, you can call EquiServe at 1-800-733-9393. Shareholders outside the U.S., Canada and Puerto Rico can call
1-781.575-4591. Our Telephone Auto-Response System is available 24 hours each day, 7 days a week. Please have your
social security number available (if applicable). To request a sale of shares, you will also need your personal identification
number (54844614). Customer Service Associates are also available weekdays from 9:00 a.m. to 5:00 p.m. Eastern Time.
PFIZER INC.
Transaction Form
Partial Withdrawal
Continue Plan participation
c=__.--J
C='-]
Deposit of Certificates
Deposit the enclosed 1-----1
number of shares. I J
I
L
Issue a cE'I1ificate for
this number of shares
Issue#: 2649 Account#: 723-47648 210
KATHARINE T AYUSO
Sell this number of shares
Signature(s) for issuance or sale and/or
change of address.
All joint owners must sign. Names must be signed exactly
as shown on this sta1ement. (Partner/Officer/Tt1lstee
must sign as Partner,'Officer,Trus1ee)
Optional Investment
Make check payable to: ,--- ]
l~~~t~~o~:!~auns~~~~sl__ _____
Your Optional Investment can be a minimum of $50.00 per
InvAstment and a maximum of $120,000.00 per year
Full Withdrawal Terminate Plan participation
r ----'jlssue a certificate for all full shares and
I a check for fractional shares
~---
i--l Sell all Plan shares
Address change or share transfer
Mark bo)( and complete the appropriate
pof~on on the reverse side I
r-1
'----J
02649 00723 47648 90
REV 150B EX+ i6-9B) ..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
AYUSO, KATHARINE 1.
FilE NUMBER
.2./ - 2004-01064
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorsnip must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
31 books
31.00
2 2 lamps, small desk & chair
80.00
3 27" Sanyo color TV & stand
375.00
This lady lived in a nursing home lor 3 years and had given everything 10 friends prior to death
IRA payable to estate
4 1,613.955 sh Income Id 01 America AMECX
(mutual fund)
29,147.96
5 Prepaid Cremation account, Auer Memorial Home & Cremation Ser. Inc. Harrisburg PA
1,065.00
No other bank accounts as checks were written on brokage account
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
30,698.96
Kay Ayuso Individual Account
Mutual Fund Sumbol Close 11/08/04 DaD # of Shares Total
AGTHX 25.26 1,404.893 $35,487.60
AMECX 18.06 2,522.588 $45,557.94
AIBAX 10.87 2,753.121 $29,926.43
ANWPX 26.4 1,107.444 $29,236.52
PGIBX 18.37 995.757 $18,292.06
SVM 12.57 (avg of Hi and La 1,000 $12,570.00
AWSHX 30.21 2,223.379 $67,168.28
Kay Ayuso IRA
Mutual Fund Svmbol
AMECX I
Close 11/08/04 DaD # of Shares T alai
18.06 I 1,613.951 I $29,147.961
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r
REV-'511 EX+ 1'2-991*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
AYUSO, KATHARINE T
FILE NUMBER
:J. I - 2004-01064
Debts 01 decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
I.
FUNERAL EXPENSES:
Auer Memorial Home & Cremation Ser. Inc., Harrisburg PA
Transport remains to Mt Auburn Cemetery, Cambridge MA,
(cremation service)
hotel, meals, transportation
1,06500
461.00
2
B. ADMINISTRATIVE COSTS:
1.
Personal Representative's Commissions
Name of Personal Representative(s) Peter B Shultzabarger
Social Security Number{sjlEIN Number of Personal Representative{s) 170362097
St"",tAddress 341 Barnstable Rd
0.00
City Carlisle
Year(s) Commission Paid: NA
State PA
Zip 17013
2.
Attorney Fees
19.00
3
Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation)
0.00
Claimant
Street Add ress
City
State
,Zip
Relationship of Claimant to Decedent
4.
Probate Fees
270.00
5.
Accountant's Fees
000
6.
Tax Return Preparer's Fees
000
7.
TOTAL (Also enter on line 9, Recapitulation) $
1,81500
III more space is needed, insert additional sheets of the same size)
REV-1512 EX+(12-03)
..
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE L1ABIUTIES, & LIENS
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETIJRN
RESIDENT DECEDENT
ESTATE OF
AYUSO, KATHARINE T.
FILE NUMBER
2004-01064
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, Including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
VALUE AT DATE
OF DEATH
1. Dr. Paul J Creeden, DPM, Carlisle PA
20.00
2 Presbyterian Homes, Inc., Swaim Health Center, Newville PA (nursing care)
2,095.83
3 Margin debit on Wachovia brokerage acet # 1239-9913 (see attachment)
22,71483
TOTAL (Also enter on line 10, Recapitulation) $
24,83066
(If more space is needed, insert additional sheets of the same size)
SWAIM HEALTH CENTER
210 BIG SPRING ROAD
NEWVILLE PA 17241-9486
.
ACCOUNTS RECEIVABLE STATEMENT
Statement Date: 11/3012004
RETIREMENT AND SENIOR
CARE SERVICES
Balance Due: 2,095.83
BuIUIIl'l' Dul' l pOll Rl'l'eipt
KATHARINE AYUSO
clo KATHARINE T AYUSO
210 BIG SPRING ROAD
SWAIM CENTER
NEWVILLE PA 17241
RETURN one copy with your remittance;
RET AJN one copy for your records.
This is the only copy you will receive.
Account Number: 60987
Balance Forward: 7,091.65
~;'~l:@IIIIi!I~.!;!lIr/~i:!llf!a!\'!f,'~J_",,,,_~~~J!Iij~~_'~l,"'1II IH
11/0212004 -11/0212004 Cntam Anti-Fungal 1.00 18.93 7,110.58
11/0212004-11/0212004 Shamp/BodyWash8.5oz 1.00 2.15 7,112.73
11104/2004-11/04/2004 WipeTena 1.00 8.41 7.121.14
11/04/2004 -11/04/2004 PAD PROMISE REG 15# BLUE 1.00 43.99 7.165.13
11/07/2004 -11/07/2004 Telephone 1.00 21.20 7.186.33
11/07/2004 -11/07/2004 Oxygen Daily 7.00 38.50 7,224.83
11/0812004 -11/30/2004 RoomIBoard-SelfPay (23.00) (5, 129.00} 2.095.83
TOTAL:
(4.995.82)
0.00
2.095.83
Page j at /
Shultzabarger, Pete
From: bonnie.french@wachoviasec.com
Sent: Wednesday, December 29,20045:24 PM
To: Pete Shultzabarger
Subject: RE: Kay Ayuso
Pete:
I recieved the documents today, and will be booking them onto Kay's Estate account. Once they are fully on the
account, I will be moving over assets. I inquired about the check you have that is made out to Kay, yes that can
be deposited into the Estate account.
As far as the margin debit on the account on 11/8 this is how I have calculated it:
Debit off of 10/31/04 Statement:
Transactions made prior to date of death, 11/08/04:
$24,165.24
97.41 DIV 11/01 credit
17.00 Visa 11/02 debit
22.00 Visa 11/02 debit
1,392.00 ACH Deposit 11/03 credit
$22,714.83- estimated amount of debit on
11/8/04
Please let me know if you have any questions.
Bonnie K French
Registered Account Administrator
(617) 289-9512
The information is not warranted as to completeness or accuracy, nor does it serve as an official record of your
account. Your official Trade Confirmation and/or Client Account Statement are the official records of your account.
Further, since the confidentiality of internet e-mail cannot be guaranteed, please do not include private or
confidential information (passwords, account numbers, social security numbers, etc.) or instructions requiring your
authorization (orders, address changes, funds transfers, etc.) in your e-mail communication to us.
Wachovia Securities, LLC, Member SIPC, 901 East Byrd Street, Richmond, VA 23219
"Pete Shultzabarger" <pshultzabarger@phi-
preshomes.org>
12/27/200402:01 PM
To <bonnie,french@wachoviasec.com>
cc
Subject RE: Kay Ayuso
You should receive all the forms today. With regard to the information below about the value of Kay's assets on
11/8. Since there was a debit I will need to know how much debit was on her account as of 11/8. I will need to
show that on the PA state inheritance tax form, thanks
Pete Shultzabarger
Regional Dir for Mission Support
2/3/2005
REV.1513 EX. {9<JOI ..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
AYuso. i<A-rHAR /IV IE. T
NUMBER
[
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS ~oclude outright spousal distributions, and transfern under
Sec. 9116 (a) (1.2)1
JANET H SHULTZABARGER 341 Barnstable Rd, Carlisle PA 17013
FILE NUMBER
.2./- .2.". 'I - t!>/o ~ <I
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Nol LlotTrusl8e(s) OF ESTATE
1
collateral
100.0;6
ENTER DOlLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE. ON REV-I500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
000
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
0.00
TOTAL OF PART 11- ENTER TOTAL NOK-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-l500 COVER SHEET $
0.00
(If more space is needed, insert additional sheets of the same size)
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717)240-6345
Date: 02/28/2005
SHULTZABARGER PETER B
341 BARNSTABLE ROAD
CARLISLE, PA 17013
RE: Estate of AYUSO KATHARINE T
File Number: 2004-01064
Dear Sir/Madam:
It has come to my attention that you have not filed the
Certification of Notice Under Rule 5.6 (a) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES,
NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on
or after July 1, 1992, the personal representative or his
counsel, within ten (10) days after giving proper notice to the
beneficiaries and intestate heirs as required by subdivision
(a) of Rule 5.7, shall file with the Register of Wills or Clerk
of the Orphans' Court his/her Certification of Notice.
This filing is due by:
03/01/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~F:t=!:s:;r
Clerk of the Orphans' Court
cc: File
Counsel
Judge
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
J\A-i/-14R./N E
7:
A YLJSo
Date of Death:
// / r;- / :>'00 't
, I
Will No.
:;JDO L} -010(" If
Admin. No. ~ / - 0 'f - /0 tLf
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on / / / / ;if f,::, 00 r :
I I
Name
Address
J"4'1"'+
H, S/,{}/fz.Q/.,Qr'J8V- / 3'1/
~ql'~s~.,J)e tel C-rrIJ L II/.
17013
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
s/.yo ~-
I
1~8. .JJ2J~
Signature
Name fe,tev-
e SL/f0i?J<-~
8 <7r 1J.s -/-'7) Ie ;( d
1,4 1701 J
C'.,!
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Address S 'II
L.q,- /'tJ-<-
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Telephone c7/0 .1 LjCj - g t '14"
Capacity: A Personal Representative
_Counsel for personal representative
o
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
phone: (717) 240-6345
Date: 10/30/2006
SHULTZABARGER PETER B
341 BARNSTABLE ROAD
CARLISLE, PA 17013
RE: Estate of AYUSO KATHARINE T
File Number: 2004-01064
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS I COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
wills a Status Report of completed or uncompleted administration.
This filing is due by: 11/08/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
M', ~">~' j}
. ,,' I '/
_~ ' ,~, A~/fAAI~'
/./
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
r)
Register of Wills of Cumberland County
STATUS REPORT UNDER RULE 6.12
Name of Decedent: k q f tn~ ilflL 7
,
)l Vi.IS <:'
I
Date of Death:
Nt/v.
g
J. z> C' L/
Estate No.:
."2Z"'c"' t./ - () / c t, 4
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion ofthe administration of the above-captioned estate:
1. State whether administration ofthe estate is complete:
Yes 00 No 0
2. Ifthe answer is No, state when the personal representative reasonably believes that
the administration will be complete:
3. Ifthe answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes 0 No JR1
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties in
interest? Yes ~ No 0
Date: -;1 k?!./
c. Copies ofreceipts, releases, joinders and approval of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report. //. \) /:', /..~
g JC'" t f{IJu!l~~~
/ ~
Signature /
4/-I-~ v 11. 5; hl/' /-!-7-'1 ~7.ll e v
Name J
3'1 I
Address
f3c/rn S -/16/-<-
C-q ~~ l.5 J L PI!-
7/7-:241'- ~r!t;i}
Telephone No.
r?cl
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Capacity:
~ Personal Representative
o Counsel for personal representative
~
RECEIPT AND RELEASE
ST ATE OF PENNSYL V ANlA
CUMBERLAND COUNTY
In the matter of the Accounting
Of the Executor of the Estate of
Katharine T . Ayuso Deceased:
KNOW ALL MEN BY THESE PRESENTS that the undersigm~d, Janet H.
Shultzabarger(Beneficiary) being of full age, does hereby acknowledge receipt from
Peter B. Shultzabarger, as Executor of the Estate of Katharine T. Ayuso, deceased (Peter
B. Shultzabarger and Katharine T. Ayuso) of the property listed in Sch(;:dule A to this
Receipt and Release (the "Property") in full payment and satisfaction of the bequest to
the undersigned by part (a) of Article* of the Last Will and Testament of the Decedent
(the "Bequest"), and, in consideration thereof, the undersigned does hereby:
FIRST: Remise, release, and forever discharge the Executors, individually and as
such Executors, of and from any and every claim, demand, action, and Gause of action,
account, reckoning and liability of every kind and nature for and on account of any and
every matter and thing whatever arising from or in any manner relating to, or connected
with, the distribution of the Property to the undersigned in full payment and satisfaction
of the Bequest.
SECOND: Certify that the undersigned has made no sale, mortgage, pledge,
assignment, gift, or other transfer of the right, title, and interest in and to the Property
herein distributed to the undersigned in full payment and satisfaction of the Bequest.
THIRD: Agree that the undersigned does hereby indemnify and save harmless
the Executors, individually and as such Executors, of and from any and all liabilities,
damages, losses, charges, fees, costs, and expenses of whatever kind or nature (including
reasonable counsel fees) which the Executors shall at any time sustain or incur by reason
of any objection, demand, or claim of whatever kind or nature for, upon, or by reason of,
the distribution of the Property to the undersigned in full payment and satisfaction of the
Bequest.
FOURTH: Agree that this Receipt and Release shall be binding upon the heirs,
distributes, executors, administrators, legal representatives, and assigns of the
undersigned, and shall inure to the benefit of heirs, distributes, executors, administrators,
legal representatives, and assigns of the Executors.
___lAllie T /l51}~!l2u/.;tc0~
Beneficiary Print J
Date: October 23,2005
~~(~ '1/ ~4.;,-:t.5a,uf(U;
Ign ,(.J
Estate of Katharine T . Ayuso
Receipt and Release
Schedule A
1,245.355
Shares of common stock, pfizer, Inc.
1,404.89300
Shares of Growth Fund of America
4,274.173
Shares of Income Fund of America
2,825.070
Shares of Intermediate Bond Fund of America
738.712
Shares of New Perspective
1,248.331
Shares of Washing Mutual Investment Fund
Estate of KATHARINE T. AYUSO
Final Accounting
October 30, 2005
Stocks and Mutual Funds
Cash and brokerage checking account
272,766.38
30,698.96
Total value of assets at death 11/8/2004
Gain on investments 11/8/2004 to 10/21/2005
20,036.54
Total assets before distributions and expenses
Expenses to Estate
Dr Paul Creeden
Presbyterian Homes,Inc
Margin debit on Wachovia brokerage account
Funeral expenses
Probate fee
Attorney fee
Inheritance tax filing fee
Inheritance Tax
20.00
2,095.83
22,714.83
3,026.00
270.100
19.100
15.00
39,446.80
Total expenses
Total available for distribution
Submitted by Peter B. Shultzabarger, Executor
$303,465.34
$323,501.88
$67,607.46
$255,894.42